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Organization
KEEGAN BAKER, LCSW, PLLC
Active
Organization
KEEGAN BAKER, LCSW, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAINE KEEGAN BAKER LCSW (CLINICAL SOCIAL WORKER)
(631) 833-5677
Entity
Organization
Contact information
Practice address
267 E MAIN ST, SMITHTOWN, NY 11787-2874
(631) 833-5677
Mailing address
3 SETALCOTT PL, SETAUKET, NY 11733-1315
(631) 833-5677
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
085486
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467727412
—
NY
Enumeration date
07/14/2017
Last updated
07/14/2017
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